UMEM Educational Pearls

Title: Beta-Lactam Allergies in Sepsis (Submitted by Ashley Martinelli)

Category: Pharmacology & Therapeutics

Keywords: Beta-Lactam, Allergies, Sepsis (PubMed Search)

Posted: 11/7/2020 by Wesley Oliver
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Allergy documentation in the medical record is not always clear, nor does it provide clarifying details to understand timing and severity of beta-lactam allergies. Approximately 8-10% of the population report beta-lactam allergies and 90% of those are not IgE-mediated reactions that would preclude the use of this class.

A recent retrospective, single-center study of 438 patients was performed to assess the impact of these allergies on mortality and time to effective antibiotics in sepsis or septic shock.

-26% of the patients reported a beta-lactam allergy

-No significant differences with respect to primary source of infection (bacteremia and UTI most common)

-No difference in incidence of prior resistant organisms

Results:

-Overall, there was no difference in the combined endpoint of in-hospital mortality or transfer to hospice, time to antibiotics, ICU length of stay, hospital length of stay, and total hospital cost

-There was a significant difference in the susceptibility of the cultured organism to the initial antibiotic therapy in patients without a beta-lactam allergy (78% vs 57% p=0.009)

Bottom line:

Clarify all beta-lactam allergies in the medical record when they are encountered as they may impact care during the hospitalization or in subsequent encounters. Do not delete the allergy, instead note the reaction or false report in the event that it is reported by the patient again in the future.

References

Komyathy KL, Judd WR, Ratliff PD, Hughes RE. Assessing mortality outcomes of beta-lactam-allergic patients presenting with sepsis. Am J Emerg Med. 2020;38(9): 1816-1819.